22 ms·

Poor sleep drove me insane, and my long path to recovery

655 points by Wagthesam 4y ago

programmarchy 4y ago
Aside from allergy treatments and surgery, you mentioned the following: nasal sprays, nasal dialators, a bumper belt, and acid reflux suppressants. Do you still use all of these, and if so, do you have a sense about what had the most impact?
- Wagthesam 4y ago
  The only one i'm not sure about is acid reflux treatment. From my own experience congestion + sleep apnea => acid reflux. But I have not seen improvement in sleep apnea from treating acid reflux. Although in the study linked in the article its shown to. Try flonase first with zyrtec and azelastine. Bumper belt only works if your apnea is positional in nature. And nasal dilators are secondary to drugs
Ralo 4y ago
I started getting sleep issues during the beginning of university and during a bodybuilding phase but I treated it as "that's what life is, you don't sleep. Welcome to adulthood." after growing up with an over weight and extreme snorer father who was very much on the stance of "shut up and be tired, that's what life is" By this point I was already getting to where it clearly wasn't normal and it's extremely affecting my life but I was so weak and exhausted that daily chores felt like I was carrying 20lbs weights on my arms. After years of broken sleep, it completely shipwrecked my schooling and gym routines. This lasted 3-4 years I thought it was backpain ruining my sleep, since I would wake up 3x a night with a sore neck and back. I decided to check with a doctor. This did nothing, they told me I was too young to have these issue and just needed to fix my routine. I tried some basic tips, fixed sleeping times, new bed, new office chair. etc. Didn't change a thing. I ended up learning that I snore. Being single all of university, I never heard this. I started looking into this on my own and it was an absolute eye opener [0][1][2]. I never realized how important nose breathing is. It's not at all the same as just breathing through you mouth. I always had issues breathing through my nose when sleeping and always just breathed through my mouth. I would wake up with a completely dry mouth. This is bad for your teeth, it changes your jaw structure, and allows you to choke during sleep. I always assumed snoring was an annoying but harmless thing that guys did but it was your body literally fighting death each night. It's no joke. I watched one video of someone describing exactly what I was having and he said he would use nasal strips and a piece of tape to cover your mouth[0]. I thought it was nuts but I was willing to do anything. I gave it a shot and just using those nasal strips was absolutely mind blowing. I have been missing this oxygen my whole life. I gave it a shot with the mouth taping and I couldn't believe how well it worked. I was having dreams again, I haven't dreamt in years. Deep vivid dreams. I would wake up and just be 100% the next day. My back and neck pain went away with it as well which turns out was it being caused by me tossing and turning all night. I have not been diagnosed with sleep apnea but I'm sure I would. The sleep study waitlist is 3-4 years in my country so it will be a long time before I can get the chance. I fully understand, this is NOT the recommended approach but for some reason this whole topic is never discussed. You need to find this out on your own and when you do, it's not treated as a "medical problem". Getting diagnosed with sleep apnea doesn't even get your CPAP machine covered under medical insurance. It's a $1-2k machine you need to pay out of pocket. Plus distilled water. For a broke student, I did what I could and it absolutely changed everything. If that means $30/month in nose strips and a roll of medical tape every 3rd month, I'll do it. It seemed a bit dangerous to use a piece of duct tape with holes in it, so instead I use a tiny tiny piece of medical tape so if I need to open my mouth I can. It's more so used as a passive reminder to my jaw to stay shut and I wake up with that tape still in the same place. No, Youtubing your way to a diagnosis is not how you fix issues but it really felt like no one was helping or taking it serious. [0]https://www.youtube.com/watch?v=g8JzXEoT9LI https://www.youtube.com/watch?v=g8JzXEoT9LI [1]https://www.youtube.com/watch?v=xivXNQPMGHA https://www.youtube.com/watch?v=xivXNQPMGHA [2]https://www.youtube.com/watch?v=-VvMLcwG9KQ https://www.youtube.com/watch?v=-VvMLcwG9KQ
- Wagthesam 4y ago
  I will add you can get a second hand off a marketplace cpap machine without a prescription. I think many go this route as with insurance they can take it away if they see you are struggling to use it.
  - jossclimb 4y ago
    I am going to get one. I have all the symptoms of sleep apnea, I wake up with a dry mouth or nose and my wife often has to wake me up as I am snoring like a fog horn. I went to my Doctor and they got me rigged up for a sleep test with a load of sensors, but I could not fall asleep, the whole premise of 'i must sleep so the machine can record me, resulting in me not sleeping at all' and being told I had a negative test result.
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Wagthesam 4y ago
This is quite raw and I'm actually somewhat afraid to share this. But I think sleep apnea is criminally under-discussed and underdiagnosed. It can f your life up sideways and can take years to diagnose. So sharing my story and hope I can advocate for it. If you have sleep apnea, no amount of sleep gadgets, good habits, exercise, will help you. You must fix the root cause
- 2devnull 4y ago
  Flonase and air filters rather than cpap is the answer for many it seems. I wish the sleep medicine doctors and apnea specialists were more knowledgeable about that.
- iForgotMyPW 4y ago
  do you think the under-diagnosing is because of work schedules? dont you have to do a sleep study to get diagnosed?
  - Wagthesam 4y ago
    I have some ideas for under-diagnosis: 1) Reluctance to seek treatment for something that can be still tolerated 2) Incorrect assumption that sleep apnea only affects overweight people that snore by a large portion of the medical community 3) Lack of connection between poor sleep and symptoms. By the time you experience symptoms, you've probably had years of progressively poor sleep so its hard to connect A=>B 4) Doctors through their training are ground to the bone and have to sleep 2-3 hours during their residency. I think there is some innate resistance to the idea that sleep is important in the general medical field 5) Lack of communication between specialties. See a therapist / psych person and they won't know sleep. See a allergist and they won't know sleep. See a sleep doctor and they won't give ENT or allergy advice. Etc. Yes you need medical care to get diagnosis and treat. But its a multifaceted illness, you need a team of specialists and doctors treating you in the different aspects.
- deleted 4y ago
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matv 4y ago
This is so transparent and has great advice if you read it carefully. Thanks for sharing!
tsunamifury 4y ago
Had this, definitely nearly had a mental break down and panic attacks. Solution for me ended up being: 1) Drinking less as relaxed breathing triggered it 2) Walking long distances while practicing breathing deeply and hill climbing to build cardio and stronger lungs. After that I had almost no issues, fixed it like a charm. YMMV
- tresil 4y ago
  Thanks for sharing what worked for you. I've been wondering if light-moderate drinking might be affecting me, and it seems to be a common thread in what I'm reading about this condition.
  - deleted 4y ago
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  - Wagthesam 4y ago
    Drinking induces sleep apnea for me. If I go out for drinks I will end up feeling like I completely regressed for a few days / up to a week. It relaxes the soft palette during sleep and causes major apnea / hypopnea events.
djmips 4y ago
I had some issues like this but only manifested when I was on work trips which lasted weeks to months. I can tough out several days of sleeping in a hotel but the longer the stay the more I react to whatever is common to hotel rooms and the problems breathing / and sleep apnea gradually push me around the bend. Returning home cures me after a recovery period.
- ehnto 4y ago
  I wonder, do the hotels you stay at differentiate the smoking and non-smoking rooms? Where I live does, I once accidentally booked a smoking room and I could not sleep at all. It felt like I was burning my esophagus. I suspect smokers just don't feel how inflamed their airways are anymore, otherwise I have no idea how anyone could live like that.
  - throwanem 4y ago
    You do get used to it. It's not till you quit that you realize how poorly you were breathing before you did.
  - sgtnoodle 4y ago
    I'm not a smoker, but nicotine does have an anti-inflammatory effect. Maybe it balances out if you're the one smoking?
- forcemajeure 4y ago
  Maybe the air-conditioning is drying out your sinus?
  - djmips 4y ago
    Very likely!
rosebay 4y ago
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DoreenMichele 4y ago
Yes, you need to treat the actual underlying condition causing issues. Lots of health issues interfere with sleep. Muscle tension was another confounding factor. I was tense all the time. Treating muscle tension improved my symptoms, but it was only a band-aid. Potassium deficiency can cause muscle tension or cramping and will also cause poor sleep.
- Wagthesam 4y ago
  Not mentioned in the article but I also tried this. It worked in the short term but it was ultimately not the root cause as my symptoms persisted past it
qvrjuec 4y ago
This really resonated with me - I went through almost the same experience, with allergies and UARS almost destroying my life. The worst part about this for me was what you described as root causing self issues, something that we had to do while also experiencing issues with memory and cognition caused by the problem we were trying to solve. What a terrible catch-22
uptownfunk 4y ago
Getting to sleep early, getting up early 1hr before sunrise, diet and exercise - been absolutely priceless change for my life. You don’t get your life back, not even a second. Old age sneaks up on you and once it’s there it never goes away. I had to go through a complete burnout on my job to make these changes. In some way a blessing in disguise. But don’t wait till it’s too late. Prioritize these small changes little by little.
PrivateButts 4y ago
Sleep Apnea has f'd up the last ten years of my life. Like many, it happened so gradually that I didn't notice until I was stuck in a vicious depressive loop that wrecked my health. If I hadn't had heard of sleep apnea through a podcast of all things I probably wouldn't have ever figured it out. I was apparently the worst case they've seen in a young patient at that office. It's taken two years for me to recover, and I'm still left with a lot of the damage I did to myself. So if you're tired all the time, or you're a 'heavy snorer', or you're falling asleep during your morning routine, or wake up feeling like your drunk, get tested! They have at home test for it, it's not that bad.
porphyra 4y ago
I have a horrible snoring issue and I have some problems with burnout, "brain fog", and inability to stay focused. I have a snorelab score in the 50s and my wife kicked me out of our bedroom since she can't sleep. I did a take-home sleep study with Kaiser once but they said I just have mild disordered sleeping but no apnea. I'm not super fat or anything either (BMI = 23.9). It seems like I very likely have something similar to what OP has but I don't know how to get diagnosed properly. It's really hard to get a hold of Kaiser's head and neck surgery department too since they only take appointments by referral and can only be reached by voice message on the phone.
- Wagthesam 4y ago
  if you have the money, Dr. Kasey Li is the best sleep apnea surgeon in the bay area, possibly the world. He is the protoge of dr Christian Guilleminaul who is the founder of sleep apnea medicine. He does MMA and EASE, both of which solve structural issues if you have narrow airways. He also won't do it unless he thinks it will truly make a difference. One friend went to him for a MMA but he turned him away and referred him to cheaper surgeon as he thought the procedure would only partially help in his case. You are paying a down payment on a house though if you go with him
  - theonething 4y ago
    He doesn't accept any insurance?
    - Wagthesam 4y ago
      It is very difficult to get his procedures covered as he normally charges more than the customary rate and is out of network. I guess most of his procedures are out of pocket
- schwartzworld 4y ago
  Many cardiologists also treat CPAP, since undiagnosed apnea can result in heart issues. Probably one of them could order a sleep study. In theory your PCP could order one too, but many are uneducated on apnea. My mother's PCP said she couldn't have it because she was "too cheerful". Bear in mind, surgery is not considered the best treatment. Before you let someone cut you, you should really look at the numbers
heyzk 4y ago
Hey Samson, thanks for sharing your experience and I'm glad you persevered to diagnose and treat your condition. I think many people would have given up. I'm curious, did you track metrics past AHI and how rested you felt the next day?
sinuhe69 4y ago
I wonder if Apple Watch can detect/show signs of sleep apnea? It measures your breaths, so I theorize if you have sleep apnea, you will eventually stop breathing then wake up suddenly to breathe hard due to the lack of oxygen. So it might show as unevenly breathe rate on the watch. But I guess monitor your breathing during sleep using WiFi signals is a better solution.
- qvrjuec 4y ago
  It doesn't, but only because it polls relatively infrequently for biometric data. The increase in pulse or decrease in blood oxygen saturation is not likely to be captured if it lasts only a few seconds and the watch records a datapoint every few minutes to increase battery life
myrandomcomment 4y ago
At some point I went nearly insane. Turns out that ADHD medication can mask sleep apnea. You need the medication but when you cannot sleep properly you go from meditation that is good for your to acting like a meth addict when your actual sleep is 2 hour a night for 2 years. At the worse point of crazy the doctors figured if out and also asked how I was not insane?!? Honestly I was at the point of CT with contrast looking for brain tumors looking for why! All good now. Health focused. Figured out sleep issue and made huge life style changes. CPAP pressures level down to minimum now after much work, with goal to be off of it. I cannot stress how important it is to have a stable measured baseline on all available measurements you can take about your body. BP, sleep cycle, heart rate, etc. things like the Apple Watch are miracles off technology we all need to embrace. Modern medical science used correctly is a game changer. Data is king and understanding it and questioning the doctors to the point of understanding matters. A good doctor will answer your questions in detail and work with you. If yours does not, find a better doctor.
- Wagthesam 4y ago
  Good to know. I almost went down the route of getting adhd meds. Yeah a baseline is key. Having a personality baseline is important as well, a personality change was one of the biggest indicators something was very very wrong
  - myrandomcomment 4y ago
    I was not saying anything against ADHD meds. They are very important if you require them as I do. It is really important to understand your body and yourself. Sleep apnea is not a joke and people miss the signs. Major personality changes are a huge red flag.
    - Wagthesam 4y ago
      got it, thanks for making that clear. I was under the assumption that adhd masks sleep apnea, but didn't realize you can also have both
monroewalker 4y ago
Thank you for sharing! Skimmed for now, but saving this to read later. I've had a history as well of never getting good sleep so I'm curious to see what your experience was and the steps you've taken. A few things I've done that have helped a bunch: - Using BreatheRight nasal strips every night - Latex earplugs ("Mack's Pillow Soft Silicone Earplugs"). I could never sleep with foam earplugs in my ears but these are great - Sleeping with a noise machine - Getting a basic alarm clock so I can leave my phone outside the room - Getting a c02 monitor A ctrl+f on the page didn't show any c02 mentions, so I'll just say it's something I think is worth looking into for anyone having sleep trouble. My understanding from when I was looking at one to buy was there were different kind of sensors and the ones in the cheaper monitors were unreliable. I ended up getting this one [1] for $250 with the intention of returning it after getting a sense of where the levels would get to but ended up keeping it. For anyone who thinks it's at all possible to be a factor for them, I recommend getting that monitor with the plan being to just return it if you don't see anything surprising. [1] https://www.amazon.com/Aranet4-Home-Temperature-Ink-Configuration/dp/B07YY7BH2W/ref=sr_1_3?crid=3LQL2EPZUS8Y4&keywords=c02+monitor&qid=1677476594&sprefix=c02+monito%2Caps%2C145&sr=8-3&ufe=app_do%3Aamzn1.fos.18ed3cb5-28d5-4975-8bc7-93deae8f9840 https://www.amazon.com/Aranet4-Home-Temperature-Ink-Configur...
- genman 4y ago
  Getting a CO2 monitor was eye opening. We had very bad ventilation in our rental bed room and we invested considerably to get a very good ventilation solution when we got our house.
  - pfannkuchen 4y ago
    What did you do?
    - genman 4y ago
      Installed an fairly overprovisioned heat recovery ventilation system. What effectively means a lot of pipes to move the air in and out of the rooms. Nothing fancy: supply in the bedrooms, exhaust in the bathroom, etc, just a little more air volume moving. Heat recovery system (a fancy word for a aluminum heat exchange) recovers the heat going out of the house by warming the incoming air. Keeps mostly the CO2 levels way below 800 ppm, normally around 600 ppm.
eknkc 4y ago
We have 2 cats that I love but one of them makes sure that I do not get a good nights sleep. I could not find any solutions so far. On top of that my wife snores and I’ve had long periods of poor sleep as a result of this. I realised that this is an issue while traveling. Being able to properly sleep in hotels and feeling rested / clear. Trying to find solutions. Ear plugs don’t feel good and even though sleeping in the guest room helps with snoring, not the cat. (I close the door, little shit screams his lungs off in front of the door) I never slept great in my 20s either but I guess my body could cope. Now it’s screwing things up.
- Wagthesam 4y ago
  you can do immunotherapy--allergy shots. i have a friend at work with the same issues, loves his dog but it wrecks his sleep. allergy shots desensitize you to animal dander, but its a long process with weekly injections. Results in 1 year+
  - Wagthesam 4y ago
    Also, in the meantime take an antihistamine like zyrtec daily as you have allergies
  - endorphine 4y ago
    I think parent implies they wake up because of the sounds their cat makes. This is what happens for me btw and it's pretty frustrating.
    - eknkc 4y ago
      Yeah that was it. The cat jumps on me if I let him in. Meows like crazy if I don't. Maybe I should stimulate him more during the day though.
- schwartzworld 4y ago
  If it were me, that cat would either be crated at night a few rooms away, or better yet, rehomed.
- 4y ago
patrickdavey 4y ago
I found this hard to read. I have struggled with poor sleep for years (like, 10 years probably). It's not _that bad_, but, memory isn't great and definitely don't feel rested in the mornings. But I'm still reasonably functional, can hold down a job etc. A while back I got tested for sleep apnea, had a 6 or a 7 on the scale (mild). I tried the CPAP machine for 6 weeks (inside the time I could return it). My number went down to 1 or something, but, I didn't feel any different, so I gave it up (this was about a year ago, maybe a bit longer). I decided to try get to the bottom of my tiredness again and was recently at my doctors. He said it would take 3 to 6 months of using the CPAP machine before you'd know whether it would make a difference! I'm trying some other things first (giving up alcohol for 6 months as of yesterday!), taking nasal sprays and a device to stop me snoring.. Really hope something works out as it's just so annoying! I'm very jealous in a way that the author found out the root cause of their issue. Well done keeping at it! For anyone who has successfully used CPAP, did it really take 3-6 months before you found it made a difference?
- schwartzworld 4y ago
  > For anyone who has successfully used CPAP, did it really take 3-6 months before you found it made a difference? It took me a year of active effort. I was waking up multiple times a night choking, so I didn't feel like a had a choice but to stick with it. Some people don't fully wake up, so it may not seem like such an obvious thing to them. I never would have made it through without https://www.sleepfiles.com/OSCAR/ https://www.sleepfiles.com/OSCAR/ We went away for the weekend recently and I forgot the power cable for my CPAP. It was a rough trip for me, and I remember thinking "I can't believe I used to just feel like this all the time". It's not easy to sleep with something on your face. It's mentally upsetting to think you're reliant on a machine. Most people need to tweak their settings to get maximum benefit. And you're working with like 10 years of sleep debt. Why would it NOT take 3-6 months to see a difference?
- zapt02 4y ago
  It took me about six months to notice anything to be honest. I've been on it for almost two years now and I still don't feel 100% but I feel like it's a very very very slow gradual improvement.
s5300 4y ago
Currently dealing with severe sleep apnea & the near inability to breathe thru my nose as a younger, athletic in a past life, skinny & thin framed male. Unable to get started w/CPAP due to life instability, & even that isn’t going to fully fix things as I have to have other major surgery that involves surgically removing my completely wrecked scalenes (anterior & middle - scalenes are secondary breathing muscles), a septoplasty, & a large amount of physical therapy & potential other surgery to help with severe muscular issues around/relating to my diaphragm (primary breathing muscle) I’m affected in most ways he’s mentioned - but one thing I didn’t see is & what in the grand scheme of things is kinda dumb - is that chronic mouth breathing absolutely wrecked my once chisel-sharp jawline. Hoping one day after a few years of breathing thru my nose & postural improvement it will somewhat reappear. I furthermore got completely shitrekt from the most wildly near-unbelievable thing - I have a mattress (from a company with owners who were HN users & described severe quality control issues with their mattresses that conveniently lined up near the time I purchased it - very fun lawsuit) that was apparently made with a sufficient amount of fiberglass (textile fiberglass, a bit different from insulation you’ve probably seen before) & the mattress leaked a ridiculous amount of fiberglass through both the bottom & top of the mattress. Having carpeted floors, I was vacuuming underneath the mattress for years, not knowing that was sending it into the entire HVAC system of my house. Eventually found out everything was coming from the mattress… & though I could go on, absolute shitshow. Now, normally this wouldn’t be the worst thing as a young college person typically spends a good amount of time out of their house & in fresh air. I was unfortunately on bed rest, mostly in my room (ground zero of fiberglass mattress biohazard), for around two years as coronavirus canceled my aforementioned major surgery four times over the course of 1.5-2 years. Reason in mentioning this: a large amount of mattresses HN demographic may find themselves ordering (e.g. on Amazon/the internet in general) are made partially of fiberglass. It’s such a large issue it’s now made it into LA Times articles - I can only recommend anybody check their brand in a google search with “fiberglass mattress” (maybe site:reddit.com as well) Now, the good news is that it’s typically only an issue if you remove the zipper covering & release it, & you’ll likely quickly notice. Unfortunately in some it will still leak out of the bottom of the mattress over time (shedding, from pine needles like a tree) & unfortunately for me - mine happened to be an ultra-specific case where the manufacturer didn’t even have a zipper removable cover. It was just a breathable mesh & the fiberglass poked out of both the bottom & top of the mattress, in unbelievable amounts. I’m thankful for my 4k iPhone camera, else documenting it in my situation would’ve been near impossible. Anyways, fuck you mattress company that used to talk shop on HN. Breathing textile fiberglass shards in my room & entire house for 2+ years wrecked my airways to an unforgivable degree.
radu_floricica 4y ago
This makes me really happy, and will probably make me try again to fix my own sleep issues. They're eerily similar, except I haven't found a clear cause yet. Decade old maintenance insomnia, I wake up a 1-2 hours earlier than needed. I did all the obvious testing and keep hitting hit a brick wall. Polysomnography, SSRIs, MRIs, therapy, drugs, every supplement on the market... I was clearly told not 6 months ago that every avenue is tapped out. Except I had no idea UARS existed, nor that allergies may have something to do with sleep quality - and both are legitimate directions to follow in my case.
- Wagthesam 4y ago
  Polysomnography is definitive for UARS. If you had a negative result, either do it again. But if its consistently negative then you do not have UARS as you do not have microarousals
a-dub 4y ago
nasacort/flonase can be quite good for opening up congestion, but please beware of any vision symptoms as both are associated with glaucoma and cataracts under long term use regimes. read the insert/talk to your doctor. that said, these days i swear by melatonin. sleep deprivation is no joke at all.
- joveian 4y ago
  Also the headaches and nausea are no joke either. I can't recall the details but it was one of the worst medical reactions I've had and it took too long to notice. Be careful with flonase.
culebron21 4y ago
Very useful read. My friend, an osteopath, says neck issues also can create breathing obstructions, and it makes a good deal of people wake up in the middle of the night and stay awake, even though they don't even think it's a problem. Symptom to watch for: you wake up and your nose is stuffy, can't breathe through it, but there's no snot. And in 5-15 minutes it gets clear. If you have it, it means lymph flow out of the head is obstructed, and works only thanks to gravity when you're upright. It's a reason to be worried by itself, beacuse it also causes blood circulation obstructions. But if someone has issues with throat, it can contribute to apnea.
- legojoey17 4y ago
  Thanks for sharing, this seems like what happens to me except only partially (1 nostril fully congested and the other partially). I've only recently self-educated myself on nasal and sinus obstruction issues after particularly bad congestion from a cold. I used Afrin for one night and realized that my typical night was far from breathable compared to that.
  - Wagthesam 4y ago
    My ENT gave me afrin and used it as a diagnostic tool
- findthewords 4y ago
  Thank you, very useful information. Never thought of neck problems but my ergonomic situation has been bad for a couple of years now and lines up with these problems.
- M5x7wI3CmbEem10 4y ago
  what’s the solution to congestion?
  - rednerrus 4y ago
    My CPAP with warm wet air in it has fixed mine.
jackblemming 4y ago
I don't know if I actually buy this cause and effect. The writing and other hints sounded like some kind of neuroticism unrelated to sleep apnea. I wouldn't be surprised if it comes back in the future and the author "finds" some other cause such as eating gluten or anything else en repeat.
- n8henrie 4y ago
  I'm also curious as to the conclusions drawn -- it seems like there were a lot of relevant potentially confounding variables changed. Was there a followup sleep study? Or something to confirm the suspicion of an alternative form of OSA (upper airway something something)? I don't think I have OSA, and I've always had poor sleep (ongoing), but going on allergy immunotherapy shots has tremendously improved my quality of life.
  - Wagthesam 4y ago
    I did not put strict detail in the medical interventions as this is not meant to replace medical advise and its not as engaging in story form to list things rigorously But I did followup home tests after treating it, and have done polysomnography which is the gold standard of diagnostic test. I also wear continuous spo2 monitoring on a monthly basis to see where I am from my own device bought on amazon To treat, I needed a team of specialists (sleep doctor, allergist, ent, maxillofacial surgeon, GPs, and a gastroenterologist) to tackle the various causes and measure the effect. I also consulted Dr Kasey Li, probably the world's leading expert on sleep apnea surgery. He recommended his own surgery expanding the maxilla, but I don't think I need to go that far as its very expensive and I am much better today. I've seen several sleep doctors, will list Dr Sinha at peninsula as someone I would recommend, along with AXG Sleep Diagnostics for an affordable polysomngraphy if you need to pay out of pocket. For ENT, I will also recommend Dr Gerald Kangelaris (skilled surgeon) in SF and Dr Andrew Murr (head of ucsf ENT) if you need a second opinion Also a lot of my interventions are done daily. So if I miss things or get lazy I can recognize if there is a difference. I also motion record myself automatically every night. In the morning I review how much I toss and turn. Its been about a year of experimentation
zhangshea 4y ago
Thanks for sharing! Sleep is the most important way for our bodies to rest, and I also have stuggled with sleep in the past. Luckily, I was able to effectively improve my sleep through getting some exercise. Your article provides a helpful approach for those who are having difficulty improving their sleep. When all else fails, it's important to consider seeking more professional treatment.
- Wagthesam 4y ago
  Yes one thing that I didn't emphasize enough was that I had a team of specialists treating me: - An ENT and a consulting ENT for a second opinion - A oral surgeon specializing in sleep apnea - Two sleep medicine doctors - Two allergists ( one for shots, one for consult ) - Multiple GP's from one medical - A gastroenterologist that did an upper gi endoscopy My message I tried to convey is that you need to own the entire process though. none of the people above will do it for you or do their job beyond their specialty
Beaver117 4y ago
I admit I haven't read the article but lately it's been popular to link mental illness to pretty common things. Poor sleep? The logic kinda makes sense. Not sleeping at all will 100% drive you insane, so it could make sense that sleeping only half what you should will have some effect. But its much more likely that some people genetically and family-wisw are just more suceptible than others. Trying to find an external cause is probably futile.
jcrben 4y ago
I had a somewhat similar experience altho different diseases. First one was gluten, and even after I figured that out it took a long time to recover from the brain fog and various aches and pains. More recently, Crohn's, altho that was more straightforward medically. The lead up to Crohn's was a period of working too hard and going out too much in San Francisco.
mawadev 4y ago
I'm glad you found the root cause and were able to fix the issues. When I started reading this, I was shocked how that workplace exploited you to the brink of your existence. To the point you lost your identity. I can relate to this, running from one fire to the next, a constant race, while the managers laugh at the margin they achieve with low staff. The extra value you create for the price of your finite time and health. I'm angry at this injustice people have to subject themselves to. I tried to identify a problem within myself for years, but realized this once I got closer to management...
- Wagthesam 4y ago
  We exist in constant competition with one another for status and worth. But thankfully in this part of my career I have more choice as to what I want to do / the level I need to sacrifice.
Razengan 4y ago
I am extremely affected by outdoors noise during sleep. Traffic, construction, kids crying, people shouting.. I try my best to convince myself "I'm perfectly comfortable, nothing's happening in my bedroom, whoever is causing that noise can not affect me in any way" but to no avail :( If the source is indoors, like the whirr of a hard disk (very annoying on recent Macs + external hard disks, constantly spinning up and down) I have to turn it off before trying to sleep. It gets so bad that even the mere anticipation of an expected noise, a clang or a honk or a yell, prevents me from falling asleep. For me it's definitely psychological than physical. Sort of an arrogant insistence that everyone and everything should be silent while I rest. Thankfully when I'm really tired I stop caring about noise and just drop like a log.
- Rechtsstaat 4y ago
  Oh man, I know that feeling of dread as you're waiting for the next shout or clank. It took some time to try out various earplugs, which at first made me sleep even worse, but once I was used to wearing them while sleeping (after 2 weeks) the difference was night and day.
- TinkersW 4y ago
  Same here, but I found that silicon earplugs really help(the foam ones do not work).
- naasking 4y ago
  Start using a white nor brown noise machine. Noise issues like this are typically because the noise has lots of variation in volume, spikes in loudness, etc. The steady droning of a white or brown noise drowns out lots of that kind of background noise. I just use my phone, lots of free apps available. Ear plugs help too, though they can be irritating sometimes.
marhee 4y ago
> And I started taking antihistamines daily. Antihistamines can make you drowsy, ie. "brain foggy": (Quoting the web) Side effects of antihistamines * sleepiness (drowsiness) and reduced co-ordination, reaction speed and judgement – do not drive or use machinery after taking these antihistamines. * dry mouth. * blurred vision. * difficulty peeing. I take them sometime myself (for the same symptoms as the article) and I really notice the drowsiness - even though it differs from time to time. So I really limit usage. > Even my lifestyle in my early 20s was a confounding issue. Did I party too hard? Did that era of my life alter my brain chemistry in a way that made me irreparably damaged? Long-term effects of recreational drugs use (this includes alcohol I would say) have be studied quite a bit I believe not much last-long effects have been found. So don't worry about it, it does not alter your brain permanently. Finally I like to say that what helped the author a lot is just a shift in focus to personal well-being. Any shift in focus helps in most cases. Taking up dancing, playing guiter, camping, whatever, can also make you feel like you can breath again. Hyperfocus, on any kind of activity, can be damaging in the long run for most people. Variety is the spice (& fresh air) of life. But note that hyperfocus includes hyperfocus on personal health, well-being and mental health issues, etc. This can also be damaging and anxiety inducing, as you try to start "fixing" everything and trying to "understand" all your root cause in a infinite loop, start comparing with others, etc. So limit the time spend there as well, I would say.
- iSnow 4y ago
  >Antihistamines can make you drowsy, ie. "brain foggy" Depends. More modern ones like Desloratadine which don't cross the blood/brain barrier usually don't do so.
- galleywest200 4y ago
  Antihistamines make my insomnia worse. They trigger my restless leg syndrome like nobody's business. Stimulants (prescribed) help me sleep, they shut my brain up.
  - KuiN 4y ago
    Restless Leg Syndrome is absolute hell. Combined with insomnia it's nearly killed me a few times. I think a lot of people (including many doctors I've dealt with) underestimate it due to it's rather benign sounding name.
tstrimple 4y ago
Hey! It's 2AM for me and I have a meeting in 4 hours and still can't fall asleep. This is pretty typical for me regardless of exercise or caffeine intake.
- naasking 4y ago
  Lots of changes you can try: https://hubermanlab.com/toolkit-for-sleep/ https://hubermanlab.com/toolkit-for-sleep/ You might also be a slow caffeine metabolizer, so even one morning coffee can disrupt your sleep for more than 24 hours.
eddyfromtheblok 4y ago
I also was offered a CPAP and I hated it. I ended up going to an acupuncturist and didn’t really have issues with sleep apnea after some treatments.
mfgs 4y ago
For anyone using or considering a CPAP device, you should also do some research into mandibular advancement devices (MADs). They’re basically a mouth guard that opens your airway by moving your lower jaw forward. They are lesser known than CPAPs but are much simpler and way less invasive. They’re often well suited for people who are thinner and/or have milder OSA symptoms. I couldn’t use a CPAP but using a MAD has helped significantly (although perhaps not completely).
- marstall 4y ago
  I have severe sleep apnea and made the switch from CPAP to MAD a couple years ago. Expensive but covered. Never looked back. Much simpler on every level, works about the same. My wife confirms I don't have apnea episodes.
  - anonu 4y ago
    When you say "covered" you mean your insurance paid for it? Are you in the USA? I understand it's not covered unless you do a series of sleep studies.
    - marstall 4y ago
      yes, in the USA, yes - covered. and I did have to have a sleep test for the cpap, but not the MAD
- Bilal_io 4y ago
  I remember my sleep doctor mentioning them as an option, but with a risk of altering the jaw's shape.
  - anonu 4y ago
    It's not really a risk. I use a MAD. In the morning I have a little insert that realigns my overbite and do 5 minutes of muscle exercises. If i don't do that i notice alignment issues when I'm chewing. If i do, it's not an issue at all throughout the day. There are studies that have shown that overbite decreases over time but it's not clear if they do the reset procedure every morning.
madaxe_again 4y ago
Sweet Jesus. The illness this young man has is an advanced case of capitalism, not sleep apnoea. While I still worked at the technology mill, my sleep was terrible, I had apnoea, I ground my teeth to stumps, and suicide was a frequent point of contemplation. I changed my life, entirely. Stopped subjecting myself to the incessant cruelties we are expected to accept as simply normal. We have an entire planet filled with people who absolutely know that something is wrong, but they can’t see the thing right in front of them, as it’s so normal and all-pervasive that it doesn’t even register as a thing that exists - so they go get the pills, the devices, the apps, and treat the symptoms so they can continue their good work at the torture factory. Things are better for me now. It required stopping giving a damn about career, success, and all that crap, and going and doing entirely my own thing. And they wonder why the birth rate is in the ditch. Stressed creatures in captivity do not reproduce.
- inkcapmushroom 4y ago
  >And they wonder why the birth rate is in the ditch. Stressed creatures in captivity do not reproduce. This seems reasonable, but I wonder why we are so much more stressed in modern first world countries than in places and times where they have had "real" problems, like figuring out how to source potable water or how to not get shot or bombed in a war-torn country. It's usually the case that the harder it is to survive an environment, the more people seem to reproduce, and birth rates go down after most citizens' well-being is secured, which would seem to run counter to the idea that stress lowers birth rates.
- DrThunder 4y ago
  Imagine thinking sleep deprivation doesn't exist in alternative economic structures... "It required stopping giving a damn about career, success, and all that crap, and going and doing entirely my own thing." So capitalism helped you. There are quite a few ism countries where 'doing your own thing' isn't an option.
jstx1 4y ago
Can something like a fitbit be used as an initial screen? Mine detects multiple very short sleep interuptions every hour during sleep and I have no idea how to interpret this. (I'm chronically tired and distracted and I have no idea where to start - sleep apnea, ADHD, food intolerances...)
- jaggirs 4y ago
  If you are chronically tired you should go see a doctor regardless of what the fitbit says.
- ansc 4y ago
  I believe that's completely normal (at least that's what my fitbit says). Unless I'm also suffering from sleep apnea of course.
- Wagthesam 4y ago
  Possibly. But you need continuous sp02 monitoring, whereas fitbits only do it a few times per hour. A take home sleep test is easy and is covered by insurance.
  - bob_theslob646 4y ago
    >A take home sleep test is easy and is covered by insurance Do you know of any other alternatives for sleep tests that are not covered by insurance? Because the reality is sleep study in the United States is incredibly expensive. I did a sleep study and the insurance billed my company over $50,000 and a take home test was 2.5 grand.
    - Wagthesam 4y ago
      that seems like inflated pricing. there are solutions from the internet for hsat (lofta and night owl) that used standardized devices. If you want a psg, there's a place in sacramento (axg sleep diagnostics) that will mail you the psg device for a night, for around 600. My hsat was covered by insurance, but I had to self fund psg and my insurance wouldn't pay for it. My sleep specialist quoted 3k, I went with axg sleep diagnostics.
dusted 4y ago
I suspect I might have this.. Do anyone know a device which can continuously measure and log blood oxygen levels ? Just a simple thing that logs to a file on an SD card ? I don't want apps or online stuff..
bowsamic 4y ago
> I had reached a stage of mental illness. One that is not aesthetic and talked about to spread awareness. But one where people would avert their eyes. This period was a dark era in my life. This is actually all mental illness, we just seem to be really bad at dealing with it as a society. It's quite shocking how little empathy or support people seem to have for "unfashionable" mental illness.
- Wagthesam 4y ago
  Yeah. Kanye is a roscharch test. Mental illness is not pleasant or even easy to pity. It will offend you. It can be disturbing, violent, and insane. I have no ideas, this is just the way things are
bitL 4y ago
How about trying acetazolamide or high dose thiamine (1500mg+) for it? They both act as carbonic anhydrase inhibitors, therefore could be used to treat altitude sickness and thus be beneficial for (central) sleep apnea as well.
- Wagthesam 4y ago
  I don't have central apnea thankfully. One thing to note
kartiksura 4y ago
I recently went through a surgery for treating my sleep apnea. I have documented my experience here. Happy to answer any of your questions https://www.quora.com/profile/Kartik-Sura/My-Struggle-with-ADHD-was-Actually-Sleep-Apnea-All-Along https://www.quora.com/profile/Kartik-Sura/My-Struggle-with-A...
- Wagthesam 4y ago
  congrats on your recovery!
spirit557 4y ago
I'm trying to understand how exactly do they know sometimes if there is central sleep apnea or obstructive sleep apnea happening with the tests. Is a CPAP or other machine helpful for central sleep apnea?
- david-gpu 4y ago
  When CPAP machines detect that the airflow has stopped for a few seconds, they send a series of little air puffs to determine whether the airway is still open (non-obstructive apnea) or blocked (obstructive apnea). The puffs are gentle enough that they don't wake you up and don't force the airway open.
- elric 4y ago
  If you're talking full-blown sleep study with all the sensors, then it's pretty easy. If you're attempting to breathe but no air goes in: it's obstructive. If you're not attempting to breathe, it's central. You can detect whether or not someone is trying to breathe by looking at the chest strap reading. The cause of central apneas isn't always clear, but at high CPAP pressures it can be caused by CPAP, because it can end up blowing off CO2, and breathing is done primarily in response to an increase in CO2.
- Wagthesam 4y ago
  if you suspect central sleep apnea, you need to work with a specialist that has done research in central sleep apnea. Its a poorly understood condition. But from my understanding treatment is different
petesergeant 4y ago
I’m a member of an entrepreneurs forum where every so often someone will ask about improving their sleep. People are willing to try literally any pill they can source or rare Chinese medicine or vinegar diet or whatever, but what they are usually not willing to do is go and get a sleep study done and find out if they have sleep apnea.
FollowingTheDao 4y ago
I share here with you all that sleep apnea can be cured. I helped cure a friend by using her genetics and diet/life changes. No more mask. And her fatigue an peripheral neuralgia is gone. It had to do, for her, Vitamin D3, catalase, and selenium. This increased her somatostatin levels, growth hormone levels, and lowered her H2O2. https://pubmed.ncbi.nlm.nih.gov/29482804/ https://pubmed.ncbi.nlm.nih.gov/29482804/ https://www.acpjournals.org/doi/abs/10.7326/0003-4819-121-7-199410010-00002 https://www.acpjournals.org/doi/abs/10.7326/0003-4819-121-7-... Genetically, she is predisposed to very high levels of IFGBP3 and very low levels of catalase. She also has hasimotos (autoimmune thyroid) which I am sure will go away next. https://europepmc.org/article/med/17074268 https://europepmc.org/article/med/17074268
aantix 4y ago
I recently discovered that I’m a slow metabolizer of caffeine. Via my raw 23andme data. https://you.23andme.com/tools/data/?query=rs762551 https://you.23andme.com/tools/data/?query=rs762551 C/C genotype. https://www.geneticlifehacks.com/liver-detox-genes-cyp1a2/#CYP1A2_Genotype_report https://www.geneticlifehacks.com/liver-detox-genes-cyp1a2/#C... Instead of coffee being a net positive, it actually takes caffeine 4X the time to process through my body and increases my cardiac event risk by 2X. I can drink a cup of coffee at 8am and it still impacts my sleep the following night. My blood pressure remains really elevated (20+ points for systolic) the entire day. All these decades I’ve been ingesting coffee thinking it’s a “net positive” - not for my genotype. When the reality is I sleep like shit, my blood pressure is through the roof, I feel awful for a day or two of drinking a single cup, and it all makes sense now. I miss my coffee kick, but the fallout from it all, I just don't think it's worth it anymore at this stage of my life.
- _rs 4y ago
  Are there any services like 23andme that are more strict when it comes to data privacy or that allow me complete ownership of the data? I would love this type of analysis even at a higher cost but I am scared of what might happen in the future to this data on me and children
  - manimino 4y ago
    I have used Nebula. Did a group buy of the kits with several friends to obfuscate shipping address. Signed up via a protonmail address, and accessed the site only through VPN. Then deleted my data after downloading all of it. I believe it would be very difficult to tie my identity to my genome because of these steps.
    - nordsieck 4y ago
      > I believe it would be very difficult to tie my identity to my genome because of these steps. That probably depends on the closest relatively of yours that they have in their database. If you only have one sibling and they're in the database, you're probably boned no matter the precautions you take.
raspberry1337 4y ago
Hello WagTheSam, thanks for a good write up. Can I just ask, what air cleanser did you get? I am thinking of trying this, I don't trust my apartment buildings air vents. What is the gain compared to just opening a window - if you live in a not too toxic environment?
- endorphine 4y ago
  Opening your window during pollen season will wreck you, if you have spring allergies, for example.
  - Wagthesam 4y ago
    Yes opening windows brings in dirt and car fumes and pollen. AC and air purifiers much better for environmental health
- tencentshill 4y ago
  A DIY Corai-Rosenthal box would be the most cost-effective one. https://www.brown.edu/news/2022-12-23/corsi-cubes-study https://www.brown.edu/news/2022-12-23/corsi-cubes-study
- joveian 4y ago
  AirPura is one of the good ones: https://www.airpura.com/ https://www.airpura.com/ I have one and it felt nice, unfortunately because people smoke in the building I live I can't use it since the smell collects in the filter very quickly and they are expensive (but last a long time if not for the smell). A bunch of carbon could help with that but a) I try to avoid stuff from low wage countries as the carbon is (but not the rest of that particular air purifier as far as I could tell) and b) hopefully I can just move in the not extremely distant future. There are a few others as well, look for the better quality filters ("SuperHEPA" as AirPura calls them). As I understand it, the small particles are the ones that aggrivate allergies the most and that is exactly what the higher quality filters are better at. Only a relatively few companies have those better filters, IQAir is another one. It turns out the name HEPA doesn't mean anything for consumer filters, you need to look at the specs.
- 4y ago
nunez 4y ago
I get insomnia. I've been doing CBT-i for a month. It's been transformational. Throughout this experience, I've learned a lot about sleep that I wouldn't have learned otherwise. 8 hours of sleep per day is generally a myth. The amount of sleep people need varies from person to person. Ironically, fixating on getting eight hours can cause some people to get insomnia. Insomnia is a condition that is often caused by something (like work stress for the author) but drastically overstays its welcome. My CBT-i program emphasizes that trying to determine the root cause of the insomnia is pointless because of this phenomenon. This theory of how insomnia develops is called the 3P model and was developed by Dr. Arthur Spielman in the NINE TEEN EIGHTIES. (We've been sleeping for thousands and thousands of years!) https://insomnia.sleep-disorders.net/clinical/three-factors-model https://insomnia.sleep-disorders.net/clinical/three-factors-... Sleep apnea is super duper common. But the world (well at least the US) prides itself on working harder and sleeping less. I've met tons of people who start work at 6am but "get to sleep" (usually means "get to bed") at 10pm or later, partially because they wrap up work at home. There is an over-fixation on the long-term degenerative effects of sleep. However, those effects are poorly understood because sleep in itself is poorly understood. You can't really control sleep. That blew my mind. You can train yourself to get sleepy on a schedule, but actually falling asleep isn't up to you. This is why a lot of common sleep hygiene advice isn't that effective (or is actually regressive) long-term. CBT-i focuses a lot on this in particular. Alcohol and sleeping pills DESTROY sleep. That is one of the few things about sleep that is extremely well understood. These things help people get to stage 1 sleep but inhibit the deeper sleep stages that start recovery processes. (The author took antihistamines for years. Antihistamines are used as sleep aids, though they are habit-forming and can cause gnarly insomnia when you get off of them without weaning off.) So I agree with the author. I strongly believe that ALMOST EVERYONE in the US struggles with sleep, but, like sex, talking about that is taboo and drugging your way through the solution is socially acceptable.
- DrThunder 4y ago
  I would agree with almost all of this. The worst bouts of insomnia I had were caused by going without sleep for a day or two and then starting to fixate on all the issues it might cause if I did not sleep. The anxiety surrounding the problems I would have the next day with little sleep was the biggest culprit. You stick yourself in a programmatic loop by trying so hard to make yourself sleep. As you said, sleep just happens, you don't force it. Generations of people have gone on very little sleep for decent stretches of time. It is impossible for your body to not sleep and at some point it will happen whether you want it to or not. Fixation on making your sleep better will only do the opposite. Do the main things that help sleep - exercise, no caffeine after noon or so (if you're on normal day schedule), get off the screens at night near bed time and wind down appropriately. Other than that you must take an attitude of 'So what if I don't sleep. I'll feel slightly bad tomorrow and that's about it'. You will not suffer all that many long term effects of a little sleep deprivation here and there.
deleted 4y ago
[deleted]
hobo_mark 4y ago
Without immediate access to at-home sleep test kits, could something like Sleep as Android [1] (which claims to record breathing as well) be used to find out, in a first approximation? [1] https://sleep.urbandroid.org https://sleep.urbandroid.org
- Wagthesam 4y ago
  No because the diganostic criterea is nasal restriction + sp02 decrease. Or microarousals scored manually by a specialist from an ecg. You need a physical device measuring these signals
slothtrop 4y ago
Had crippling insomnia for most of 15 years. It's the worst thing that ever happened to me and I would not wish it on anyone. I'm convinced I've lost years of my life - not just in the sense of wasted time, but shortened life. But no use being bothered about it. The mainstream knowledge is still slow to catch up, but things are better than when I was researching at the outset. All you had from online searches was boilerplate inconsistent "sleep hygiene" advice and nothing else. I took a methodological approach and cracked open some books, and spent a lot of time on google scholar / pubmed. Self-adminstered CBT-i was an important intervention, despite its flaws - you can gripe that there are blind spots (e.g. it's possible to have automatic negative thoughts through conditioning despite knowing and understanding that they are distortions, 3rd-wave approaches like MCT make it a point to handle this), but in the main, a better mental game is absolutely key. Other interventions included eliminating pornography consumption, exposure to more sunlight in the morning and daytime, limiting total time in bed, experimenting with bedding, and even dietary changes. There were others as well I can't think of right now. Basically threw the kitchen sink at it. The mistake I often see is that those afflicted will rationalize that trying interventions "will lead to anxiety". There's no reason they have to. The anxiety comes from you.
gwbas1c 4y ago
I found out I had sleep apnea mostly due to coincidence. Eventually I got jaw surgery to fix it, but there is a surprising anecdote: Shortly after I started using a CPAP, at a networking event I met someone who worked at a mental health clinic, and he told me that many of their patients with schizophrenia had a pressure setting of 18 or 19 bars. Apparently disturbed sleep can cause some rather severe mental illness. I was at 16 bars at the time. (I no longer use a CPAP post surgery.) About a year prior, there were a few times that I wondered if something actually happened, or if I was misremembering a dream. It makes me wonder if some severe forms of sleep apnea can make dream context confusing enough that it's hard to bucket memories between dreams and actual events?
- Wagthesam 4y ago
  Late stage untreated UARS is similar to a catatonic existence. I think Christian Guilleminault described this population in his research. Thankfully even my experience did not get to this point
  - bandanah12 4y ago
    can you share the paper or article?
pfes 4y ago
I also had a positive experience of taking a sleep study, getting diagnosed with partial sleep apnea, and getting surgery to open up my nasal passage. I had been wearing breathe-right strips, having been unable to sleep through the night without them.
FgvGCa79FxVkSh2 4y ago
Pininiyo3@gmail.com
FgvGCa79FxVkSh2 4y ago
pininiyo3@gmail.com
transfire 4y ago
Sadly CPAPs are money train for the medical industry. Something that probably costs about $60 to make in China will cost you ten times that up front plus $60 a month (with insurance!) Their are other permanent solutions that would work for many people, but but those have been made largely unobtainable.
71a54xd 4y ago
This happened to me after making a rash decision about a new apt in NYC. When I visited to view the apt it must've been at a time when street noise / people noise was at all time lows. About a month into living there my work productivity tanked, I started noticing patterns of depression coming back and I legitimately started to hate my life. My sleep wasn't atrocious, but I'd be jarred awake in the morning by vehicles, had to wear earplugs at night etc. This drove me to a point of literally leaving New York entirely and I don't think I'll ever go back due to my current apt (in a different state) being completely quiet, having a dedicated dark silent room to sleep in and another room for working (as I'm full remote now).
samuraixp 4y ago
So happy for the author that they discovered the solution to their chronic health issues. Some estimates suggest that 10% of the population are suffering undiagnosed health issues. Thats a lot of people whos quality of life is being potentially severely disrupted because the health system is not designed to provide deep dive diagnostics. Surely the productivity gains in solving these health issues would easily pay for themselves. I hope this is an area where AI will truely shine by providing an effective stepwise differential diagnosis for anyones set of vague symptoms and conflicting biomarkers.
ahstilde 4y ago
It's interesting he mentions allergy shots. It sounds like his doctor didn't know about sublingual immunotherapy. It's similarly effective, but much less disruptive to the ongoings of daily life. Disclaimer: I run Wyndly (https://www.wyndly.com/ https://www.wyndly.com/) a YC-backed startup that uses sublingual immunotherapy, among other allergy treatments, to help people breathe better.
- Wagthesam 4y ago
  I know about SLIT, but from my research most allergists don't mix in enough to make it comparable to shots. From studies I read you need 30-100x the dose of shots taken in monthly aggregate for it to be comparable. For example Odactra which is fda approved for dust mites is 30x the concentration of a monthly maintenance dose. I am allergic to almost everything, so I imagine it will be too costly to treat properly Also it is much less regulated as its not fda approved, so the quality you are getting is less certain than shots. I would not be surprised if the majority of SLIT use cases in the US are placebo due to cost constraints outside of the fda approved tablets covered by insurance. Yes studies is one thing and its shown clearly that its comparable, but you need the right concentrations TBH I am skeptical of startups that operate in this type of environment as theres not enough oversight. For me to be comfortable it would need to be very transparent what is going into the mix source: https://fairfieldcountyallergy.com/whats-the-story-on-allergy-drops/ https://fairfieldcountyallergy.com/whats-the-story-on-allerg... "Sublingual immunotherapy is not currently covered by health insurance companies in the United States because it is ineffective as it is done here"
  - ahstilde 4y ago
    I agree with you -- the protocol is what matters. Your concern about the dosage applies to allergy shots, too, however. At Wyndly, our protocol follows the academic research. I'll work on making this more explicit.
bob_theslob646 4y ago
If the effectiveness of sleep studies does not detect sleep apnea then how is it possible that the studies are so expensive? If they're not fully effective, why are there not other solutions?

655 points by Wagthesam 4y ago

Aside from allergy treatments and surgery, you mentioned the following: nasal sprays, nasal dialators, a bumper belt, and acid reflux suppressants. Do you still use all of these, and if so, do you have a sense about what had the most impact?

Wagthesam 4y ago
The only one i'm not sure about is acid reflux treatment. From my own experience congestion + sleep apnea => acid reflux. But I have not seen improvement in sleep apnea from treating acid reflux. Although in the study linked in the article its shown to. Try flonase first with zyrtec and azelastine. Bumper belt only works if your apnea is positional in nature. And nasal dilators are secondary to drugs

Ralo 4y ago

I started getting sleep issues during the beginning of university and during a bodybuilding phase but I treated it as "that's what life is, you don't sleep. Welcome to adulthood." after growing up with an over weight and extreme snorer father who was very much on the stance of "shut up and be tired, that's what life is" By this point I was already getting to where it clearly wasn't normal and it's extremely affecting my life but I was so weak and exhausted that daily chores felt like I was carrying 20lbs weights on my arms. After years of broken sleep, it completely shipwrecked my schooling and gym routines. This lasted 3-4 years I thought it was backpain ruining my sleep, since I would wake up 3x a night with a sore neck and back. I decided to check with a doctor. This did nothing, they told me I was too young to have these issue and just needed to fix my routine. I tried some basic tips, fixed sleeping times, new bed, new office chair. etc. Didn't change a thing. I ended up learning that I snore. Being single all of university, I never heard this. I started looking into this on my own and it was an absolute eye opener [0][1][2]. I never realized how important nose breathing is. It's not at all the same as just breathing through you mouth. I always had issues breathing through my nose when sleeping and always just breathed through my mouth. I would wake up with a completely dry mouth. This is bad for your teeth, it changes your jaw structure, and allows you to choke during sleep. I always assumed snoring was an annoying but harmless thing that guys did but it was your body literally fighting death each night. It's no joke. I watched one video of someone describing exactly what I was having and he said he would use nasal strips and a piece of tape to cover your mouth[0]. I thought it was nuts but I was willing to do anything. I gave it a shot and just using those nasal strips was absolutely mind blowing. I have been missing this oxygen my whole life. I gave it a shot with the mouth taping and I couldn't believe how well it worked. I was having dreams again, I haven't dreamt in years. Deep vivid dreams. I would wake up and just be 100% the next day. My back and neck pain went away with it as well which turns out was it being caused by me tossing and turning all night. I have not been diagnosed with sleep apnea but I'm sure I would. The sleep study waitlist is 3-4 years in my country so it will be a long time before I can get the chance. I fully understand, this is NOT the recommended approach but for some reason this whole topic is never discussed. You need to find this out on your own and when you do, it's not treated as a "medical problem". Getting diagnosed with sleep apnea doesn't even get your CPAP machine covered under medical insurance. It's a $1-2k machine you need to pay out of pocket. Plus distilled water. For a broke student, I did what I could and it absolutely changed everything. If that means $30/month in nose strips and a roll of medical tape every 3rd month, I'll do it. It seemed a bit dangerous to use a piece of duct tape with holes in it, so instead I use a tiny tiny piece of medical tape so if I need to open my mouth I can. It's more so used as a passive reminder to my jaw to stay shut and I wake up with that tape still in the same place. No, Youtubing your way to a diagnosis is not how you fix issues but it really felt like no one was helping or taking it serious. [0]https://www.youtube.com/watch?v=g8JzXEoT9LI https://www.youtube.com/watch?v=g8JzXEoT9LI [1]https://www.youtube.com/watch?v=xivXNQPMGHA https://www.youtube.com/watch?v=xivXNQPMGHA [2]https://www.youtube.com/watch?v=-VvMLcwG9KQ https://www.youtube.com/watch?v=-VvMLcwG9KQ

Wagthesam 4y ago
I will add you can get a second hand off a marketplace cpap machine without a prescription. I think many go this route as with insurance they can take it away if they see you are struggling to use it.
- jossclimb 4y ago
  I am going to get one. I have all the symptoms of sleep apnea, I wake up with a dry mouth or nose and my wife often has to wake me up as I am snoring like a fog horn. I went to my Doctor and they got me rigged up for a sleep test with a load of sensors, but I could not fall asleep, the whole premise of 'i must sleep so the machine can record me, resulting in me not sleeping at all' and being told I had a negative test result.

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Wagthesam 4y ago

This is quite raw and I'm actually somewhat afraid to share this. But I think sleep apnea is criminally under-discussed and underdiagnosed. It can f your life up sideways and can take years to diagnose. So sharing my story and hope I can advocate for it. If you have sleep apnea, no amount of sleep gadgets, good habits, exercise, will help you. You must fix the root cause

2devnull 4y ago
Flonase and air filters rather than cpap is the answer for many it seems. I wish the sleep medicine doctors and apnea specialists were more knowledgeable about that.
iForgotMyPW 4y ago
do you think the under-diagnosing is because of work schedules? dont you have to do a sleep study to get diagnosed?
- Wagthesam 4y ago
  I have some ideas for under-diagnosis: 1) Reluctance to seek treatment for something that can be still tolerated 2) Incorrect assumption that sleep apnea only affects overweight people that snore by a large portion of the medical community 3) Lack of connection between poor sleep and symptoms. By the time you experience symptoms, you've probably had years of progressively poor sleep so its hard to connect A=>B 4) Doctors through their training are ground to the bone and have to sleep 2-3 hours during their residency. I think there is some innate resistance to the idea that sleep is important in the general medical field 5) Lack of communication between specialties. See a therapist / psych person and they won't know sleep. See a allergist and they won't know sleep. See a sleep doctor and they won't give ENT or allergy advice. Etc. Yes you need medical care to get diagnosis and treat. But its a multifaceted illness, you need a team of specialists and doctors treating you in the different aspects.
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matv 4y ago

This is so transparent and has great advice if you read it carefully. Thanks for sharing!

tsunamifury 4y ago

Had this, definitely nearly had a mental break down and panic attacks. Solution for me ended up being: 1) Drinking less as relaxed breathing triggered it 2) Walking long distances while practicing breathing deeply and hill climbing to build cardio and stronger lungs. After that I had almost no issues, fixed it like a charm. YMMV

tresil 4y ago
Thanks for sharing what worked for you. I've been wondering if light-moderate drinking might be affecting me, and it seems to be a common thread in what I'm reading about this condition.
- deleted 4y ago
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- Wagthesam 4y ago
  Drinking induces sleep apnea for me. If I go out for drinks I will end up feeling like I completely regressed for a few days / up to a week. It relaxes the soft palette during sleep and causes major apnea / hypopnea events.

djmips 4y ago

I had some issues like this but only manifested when I was on work trips which lasted weeks to months. I can tough out several days of sleeping in a hotel but the longer the stay the more I react to whatever is common to hotel rooms and the problems breathing / and sleep apnea gradually push me around the bend. Returning home cures me after a recovery period.

ehnto 4y ago
I wonder, do the hotels you stay at differentiate the smoking and non-smoking rooms? Where I live does, I once accidentally booked a smoking room and I could not sleep at all. It felt like I was burning my esophagus. I suspect smokers just don't feel how inflamed their airways are anymore, otherwise I have no idea how anyone could live like that.
- throwanem 4y ago
  You do get used to it. It's not till you quit that you realize how poorly you were breathing before you did.
- sgtnoodle 4y ago
  I'm not a smoker, but nicotine does have an anti-inflammatory effect. Maybe it balances out if you're the one smoking?
forcemajeure 4y ago
Maybe the air-conditioning is drying out your sinus?
- djmips 4y ago
  Very likely!

rosebay 4y ago

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DoreenMichele 4y ago

Yes, you need to treat the actual underlying condition causing issues. Lots of health issues interfere with sleep. Muscle tension was another confounding factor. I was tense all the time. Treating muscle tension improved my symptoms, but it was only a band-aid. Potassium deficiency can cause muscle tension or cramping and will also cause poor sleep.

Wagthesam 4y ago
Not mentioned in the article but I also tried this. It worked in the short term but it was ultimately not the root cause as my symptoms persisted past it

qvrjuec 4y ago

This really resonated with me - I went through almost the same experience, with allergies and UARS almost destroying my life. The worst part about this for me was what you described as root causing self issues, something that we had to do while also experiencing issues with memory and cognition caused by the problem we were trying to solve. What a terrible catch-22

uptownfunk 4y ago

Getting to sleep early, getting up early 1hr before sunrise, diet and exercise - been absolutely priceless change for my life. You don’t get your life back, not even a second. Old age sneaks up on you and once it’s there it never goes away. I had to go through a complete burnout on my job to make these changes. In some way a blessing in disguise. But don’t wait till it’s too late. Prioritize these small changes little by little.

PrivateButts 4y ago

Sleep Apnea has f'd up the last ten years of my life. Like many, it happened so gradually that I didn't notice until I was stuck in a vicious depressive loop that wrecked my health. If I hadn't had heard of sleep apnea through a podcast of all things I probably wouldn't have ever figured it out. I was apparently the worst case they've seen in a young patient at that office. It's taken two years for me to recover, and I'm still left with a lot of the damage I did to myself. So if you're tired all the time, or you're a 'heavy snorer', or you're falling asleep during your morning routine, or wake up feeling like your drunk, get tested! They have at home test for it, it's not that bad.

porphyra 4y ago

I have a horrible snoring issue and I have some problems with burnout, "brain fog", and inability to stay focused. I have a snorelab score in the 50s and my wife kicked me out of our bedroom since she can't sleep. I did a take-home sleep study with Kaiser once but they said I just have mild disordered sleeping but no apnea. I'm not super fat or anything either (BMI = 23.9). It seems like I very likely have something similar to what OP has but I don't know how to get diagnosed properly. It's really hard to get a hold of Kaiser's head and neck surgery department too since they only take appointments by referral and can only be reached by voice message on the phone.

Wagthesam 4y ago
if you have the money, Dr. Kasey Li is the best sleep apnea surgeon in the bay area, possibly the world. He is the protoge of dr Christian Guilleminaul who is the founder of sleep apnea medicine. He does MMA and EASE, both of which solve structural issues if you have narrow airways. He also won't do it unless he thinks it will truly make a difference. One friend went to him for a MMA but he turned him away and referred him to cheaper surgeon as he thought the procedure would only partially help in his case. You are paying a down payment on a house though if you go with him
- theonething 4y ago
  He doesn't accept any insurance?
  - Wagthesam 4y ago
    It is very difficult to get his procedures covered as he normally charges more than the customary rate and is out of network. I guess most of his procedures are out of pocket
schwartzworld 4y ago
Many cardiologists also treat CPAP, since undiagnosed apnea can result in heart issues. Probably one of them could order a sleep study. In theory your PCP could order one too, but many are uneducated on apnea. My mother's PCP said she couldn't have it because she was "too cheerful". Bear in mind, surgery is not considered the best treatment. Before you let someone cut you, you should really look at the numbers

heyzk 4y ago

Hey Samson, thanks for sharing your experience and I'm glad you persevered to diagnose and treat your condition. I think many people would have given up. I'm curious, did you track metrics past AHI and how rested you felt the next day?

sinuhe69 4y ago

I wonder if Apple Watch can detect/show signs of sleep apnea? It measures your breaths, so I theorize if you have sleep apnea, you will eventually stop breathing then wake up suddenly to breathe hard due to the lack of oxygen. So it might show as unevenly breathe rate on the watch. But I guess monitor your breathing during sleep using WiFi signals is a better solution.

qvrjuec 4y ago
It doesn't, but only because it polls relatively infrequently for biometric data. The increase in pulse or decrease in blood oxygen saturation is not likely to be captured if it lasts only a few seconds and the watch records a datapoint every few minutes to increase battery life

myrandomcomment 4y ago

At some point I went nearly insane. Turns out that ADHD medication can mask sleep apnea. You need the medication but when you cannot sleep properly you go from meditation that is good for your to acting like a meth addict when your actual sleep is 2 hour a night for 2 years. At the worse point of crazy the doctors figured if out and also asked how I was not insane?!? Honestly I was at the point of CT with contrast looking for brain tumors looking for why! All good now. Health focused. Figured out sleep issue and made huge life style changes. CPAP pressures level down to minimum now after much work, with goal to be off of it. I cannot stress how important it is to have a stable measured baseline on all available measurements you can take about your body. BP, sleep cycle, heart rate, etc. things like the Apple Watch are miracles off technology we all need to embrace. Modern medical science used correctly is a game changer. Data is king and understanding it and questioning the doctors to the point of understanding matters. A good doctor will answer your questions in detail and work with you. If yours does not, find a better doctor.

Wagthesam 4y ago
Good to know. I almost went down the route of getting adhd meds. Yeah a baseline is key. Having a personality baseline is important as well, a personality change was one of the biggest indicators something was very very wrong
- myrandomcomment 4y ago
  I was not saying anything against ADHD meds. They are very important if you require them as I do. It is really important to understand your body and yourself. Sleep apnea is not a joke and people miss the signs. Major personality changes are a huge red flag.
  - Wagthesam 4y ago
    got it, thanks for making that clear. I was under the assumption that adhd masks sleep apnea, but didn't realize you can also have both

monroewalker 4y ago

Thank you for sharing! Skimmed for now, but saving this to read later. I've had a history as well of never getting good sleep so I'm curious to see what your experience was and the steps you've taken. A few things I've done that have helped a bunch: - Using BreatheRight nasal strips every night - Latex earplugs ("Mack's Pillow Soft Silicone Earplugs"). I could never sleep with foam earplugs in my ears but these are great - Sleeping with a noise machine - Getting a basic alarm clock so I can leave my phone outside the room - Getting a c02 monitor A ctrl+f on the page didn't show any c02 mentions, so I'll just say it's something I think is worth looking into for anyone having sleep trouble. My understanding from when I was looking at one to buy was there were different kind of sensors and the ones in the cheaper monitors were unreliable. I ended up getting this one [1] for $250 with the intention of returning it after getting a sense of where the levels would get to but ended up keeping it. For anyone who thinks it's at all possible to be a factor for them, I recommend getting that monitor with the plan being to just return it if you don't see anything surprising. [1] https://www.amazon.com/Aranet4-Home-Temperature-Ink-Configuration/dp/B07YY7BH2W/ref=sr_1_3?crid=3LQL2EPZUS8Y4&keywords=c02+monitor&qid=1677476594&sprefix=c02+monito%2Caps%2C145&sr=8-3&ufe=app_do%3Aamzn1.fos.18ed3cb5-28d5-4975-8bc7-93deae8f9840 https://www.amazon.com/Aranet4-Home-Temperature-Ink-Configur...

genman 4y ago
Getting a CO2 monitor was eye opening. We had very bad ventilation in our rental bed room and we invested considerably to get a very good ventilation solution when we got our house.
- pfannkuchen 4y ago
  What did you do?
  - genman 4y ago
    Installed an fairly overprovisioned heat recovery ventilation system. What effectively means a lot of pipes to move the air in and out of the rooms. Nothing fancy: supply in the bedrooms, exhaust in the bathroom, etc, just a little more air volume moving. Heat recovery system (a fancy word for a aluminum heat exchange) recovers the heat going out of the house by warming the incoming air. Keeps mostly the CO2 levels way below 800 ppm, normally around 600 ppm.

eknkc 4y ago

We have 2 cats that I love but one of them makes sure that I do not get a good nights sleep. I could not find any solutions so far. On top of that my wife snores and I’ve had long periods of poor sleep as a result of this. I realised that this is an issue while traveling. Being able to properly sleep in hotels and feeling rested / clear. Trying to find solutions. Ear plugs don’t feel good and even though sleeping in the guest room helps with snoring, not the cat. (I close the door, little shit screams his lungs off in front of the door) I never slept great in my 20s either but I guess my body could cope. Now it’s screwing things up.

Wagthesam 4y ago
you can do immunotherapy--allergy shots. i have a friend at work with the same issues, loves his dog but it wrecks his sleep. allergy shots desensitize you to animal dander, but its a long process with weekly injections. Results in 1 year+
- Wagthesam 4y ago
  Also, in the meantime take an antihistamine like zyrtec daily as you have allergies
- endorphine 4y ago
  I think parent implies they wake up because of the sounds their cat makes. This is what happens for me btw and it's pretty frustrating.
  - eknkc 4y ago
    Yeah that was it. The cat jumps on me if I let him in. Meows like crazy if I don't. Maybe I should stimulate him more during the day though.
schwartzworld 4y ago
If it were me, that cat would either be crated at night a few rooms away, or better yet, rehomed.
4y ago

patrickdavey 4y ago

I found this hard to read. I have struggled with poor sleep for years (like, 10 years probably). It's not _that bad_, but, memory isn't great and definitely don't feel rested in the mornings. But I'm still reasonably functional, can hold down a job etc. A while back I got tested for sleep apnea, had a 6 or a 7 on the scale (mild). I tried the CPAP machine for 6 weeks (inside the time I could return it). My number went down to 1 or something, but, I didn't feel any different, so I gave it up (this was about a year ago, maybe a bit longer). I decided to try get to the bottom of my tiredness again and was recently at my doctors. He said it would take 3 to 6 months of using the CPAP machine before you'd know whether it would make a difference! I'm trying some other things first (giving up alcohol for 6 months as of yesterday!), taking nasal sprays and a device to stop me snoring.. Really hope something works out as it's just so annoying! I'm very jealous in a way that the author found out the root cause of their issue. Well done keeping at it! For anyone who has successfully used CPAP, did it really take 3-6 months before you found it made a difference?

schwartzworld 4y ago
> For anyone who has successfully used CPAP, did it really take 3-6 months before you found it made a difference? It took me a year of active effort. I was waking up multiple times a night choking, so I didn't feel like a had a choice but to stick with it. Some people don't fully wake up, so it may not seem like such an obvious thing to them. I never would have made it through without https://www.sleepfiles.com/OSCAR/ https://www.sleepfiles.com/OSCAR/ We went away for the weekend recently and I forgot the power cable for my CPAP. It was a rough trip for me, and I remember thinking "I can't believe I used to just feel like this all the time". It's not easy to sleep with something on your face. It's mentally upsetting to think you're reliant on a machine. Most people need to tweak their settings to get maximum benefit. And you're working with like 10 years of sleep debt. Why would it NOT take 3-6 months to see a difference?
zapt02 4y ago
It took me about six months to notice anything to be honest. I've been on it for almost two years now and I still don't feel 100% but I feel like it's a very very very slow gradual improvement.

s5300 4y ago

Currently dealing with severe sleep apnea & the near inability to breathe thru my nose as a younger, athletic in a past life, skinny & thin framed male. Unable to get started w/CPAP due to life instability, & even that isn’t going to fully fix things as I have to have other major surgery that involves surgically removing my completely wrecked scalenes (anterior & middle - scalenes are secondary breathing muscles), a septoplasty, & a large amount of physical therapy & potential other surgery to help with severe muscular issues around/relating to my diaphragm (primary breathing muscle) I’m affected in most ways he’s mentioned - but one thing I didn’t see is & what in the grand scheme of things is kinda dumb - is that chronic mouth breathing absolutely wrecked my once chisel-sharp jawline. Hoping one day after a few years of breathing thru my nose & postural improvement it will somewhat reappear. I furthermore got completely shitrekt from the most wildly near-unbelievable thing - I have a mattress (from a company with owners who were HN users & described severe quality control issues with their mattresses that conveniently lined up near the time I purchased it - very fun lawsuit) that was apparently made with a sufficient amount of fiberglass (textile fiberglass, a bit different from insulation you’ve probably seen before) & the mattress leaked a ridiculous amount of fiberglass through both the bottom & top of the mattress. Having carpeted floors, I was vacuuming underneath the mattress for years, not knowing that was sending it into the entire HVAC system of my house. Eventually found out everything was coming from the mattress… & though I could go on, absolute shitshow. Now, normally this wouldn’t be the worst thing as a young college person typically spends a good amount of time out of their house & in fresh air. I was unfortunately on bed rest, mostly in my room (ground zero of fiberglass mattress biohazard), for around two years as coronavirus canceled my aforementioned major surgery four times over the course of 1.5-2 years. Reason in mentioning this: a large amount of mattresses HN demographic may find themselves ordering (e.g. on Amazon/the internet in general) are made partially of fiberglass. It’s such a large issue it’s now made it into LA Times articles - I can only recommend anybody check their brand in a google search with “fiberglass mattress” (maybe site:reddit.com as well) Now, the good news is that it’s typically only an issue if you remove the zipper covering & release it, & you’ll likely quickly notice. Unfortunately in some it will still leak out of the bottom of the mattress over time (shedding, from pine needles like a tree) & unfortunately for me - mine happened to be an ultra-specific case where the manufacturer didn’t even have a zipper removable cover. It was just a breathable mesh & the fiberglass poked out of both the bottom & top of the mattress, in unbelievable amounts. I’m thankful for my 4k iPhone camera, else documenting it in my situation would’ve been near impossible. Anyways, fuck you mattress company that used to talk shop on HN. Breathing textile fiberglass shards in my room & entire house for 2+ years wrecked my airways to an unforgivable degree.

radu_floricica 4y ago

This makes me really happy, and will probably make me try again to fix my own sleep issues. They're eerily similar, except I haven't found a clear cause yet. Decade old maintenance insomnia, I wake up a 1-2 hours earlier than needed. I did all the obvious testing and keep hitting hit a brick wall. Polysomnography, SSRIs, MRIs, therapy, drugs, every supplement on the market... I was clearly told not 6 months ago that every avenue is tapped out. Except I had no idea UARS existed, nor that allergies may have something to do with sleep quality - and both are legitimate directions to follow in my case.

Wagthesam 4y ago
Polysomnography is definitive for UARS. If you had a negative result, either do it again. But if its consistently negative then you do not have UARS as you do not have microarousals

a-dub 4y ago

nasacort/flonase can be quite good for opening up congestion, but please beware of any vision symptoms as both are associated with glaucoma and cataracts under long term use regimes. read the insert/talk to your doctor. that said, these days i swear by melatonin. sleep deprivation is no joke at all.

joveian 4y ago
Also the headaches and nausea are no joke either. I can't recall the details but it was one of the worst medical reactions I've had and it took too long to notice. Be careful with flonase.

culebron21 4y ago

Very useful read. My friend, an osteopath, says neck issues also can create breathing obstructions, and it makes a good deal of people wake up in the middle of the night and stay awake, even though they don't even think it's a problem. Symptom to watch for: you wake up and your nose is stuffy, can't breathe through it, but there's no snot. And in 5-15 minutes it gets clear. If you have it, it means lymph flow out of the head is obstructed, and works only thanks to gravity when you're upright. It's a reason to be worried by itself, beacuse it also causes blood circulation obstructions. But if someone has issues with throat, it can contribute to apnea.

legojoey17 4y ago
Thanks for sharing, this seems like what happens to me except only partially (1 nostril fully congested and the other partially). I've only recently self-educated myself on nasal and sinus obstruction issues after particularly bad congestion from a cold. I used Afrin for one night and realized that my typical night was far from breathable compared to that.
- Wagthesam 4y ago
  My ENT gave me afrin and used it as a diagnostic tool
findthewords 4y ago
Thank you, very useful information. Never thought of neck problems but my ergonomic situation has been bad for a couple of years now and lines up with these problems.
M5x7wI3CmbEem10 4y ago
what’s the solution to congestion?
- rednerrus 4y ago
  My CPAP with warm wet air in it has fixed mine.

jackblemming 4y ago

I don't know if I actually buy this cause and effect. The writing and other hints sounded like some kind of neuroticism unrelated to sleep apnea. I wouldn't be surprised if it comes back in the future and the author "finds" some other cause such as eating gluten or anything else en repeat.

n8henrie 4y ago
I'm also curious as to the conclusions drawn -- it seems like there were a lot of relevant potentially confounding variables changed. Was there a followup sleep study? Or something to confirm the suspicion of an alternative form of OSA (upper airway something something)? I don't think I have OSA, and I've always had poor sleep (ongoing), but going on allergy immunotherapy shots has tremendously improved my quality of life.
- Wagthesam 4y ago
  I did not put strict detail in the medical interventions as this is not meant to replace medical advise and its not as engaging in story form to list things rigorously But I did followup home tests after treating it, and have done polysomnography which is the gold standard of diagnostic test. I also wear continuous spo2 monitoring on a monthly basis to see where I am from my own device bought on amazon To treat, I needed a team of specialists (sleep doctor, allergist, ent, maxillofacial surgeon, GPs, and a gastroenterologist) to tackle the various causes and measure the effect. I also consulted Dr Kasey Li, probably the world's leading expert on sleep apnea surgery. He recommended his own surgery expanding the maxilla, but I don't think I need to go that far as its very expensive and I am much better today. I've seen several sleep doctors, will list Dr Sinha at peninsula as someone I would recommend, along with AXG Sleep Diagnostics for an affordable polysomngraphy if you need to pay out of pocket. For ENT, I will also recommend Dr Gerald Kangelaris (skilled surgeon) in SF and Dr Andrew Murr (head of ucsf ENT) if you need a second opinion Also a lot of my interventions are done daily. So if I miss things or get lazy I can recognize if there is a difference. I also motion record myself automatically every night. In the morning I review how much I toss and turn. Its been about a year of experimentation

zhangshea 4y ago

Thanks for sharing! Sleep is the most important way for our bodies to rest, and I also have stuggled with sleep in the past. Luckily, I was able to effectively improve my sleep through getting some exercise. Your article provides a helpful approach for those who are having difficulty improving their sleep. When all else fails, it's important to consider seeking more professional treatment.

Wagthesam 4y ago
Yes one thing that I didn't emphasize enough was that I had a team of specialists treating me: - An ENT and a consulting ENT for a second opinion - A oral surgeon specializing in sleep apnea - Two sleep medicine doctors - Two allergists ( one for shots, one for consult ) - Multiple GP's from one medical - A gastroenterologist that did an upper gi endoscopy My message I tried to convey is that you need to own the entire process though. none of the people above will do it for you or do their job beyond their specialty

Beaver117 4y ago

I admit I haven't read the article but lately it's been popular to link mental illness to pretty common things. Poor sleep? The logic kinda makes sense. Not sleeping at all will 100% drive you insane, so it could make sense that sleeping only half what you should will have some effect. But its much more likely that some people genetically and family-wisw are just more suceptible than others. Trying to find an external cause is probably futile.

jcrben 4y ago

I had a somewhat similar experience altho different diseases. First one was gluten, and even after I figured that out it took a long time to recover from the brain fog and various aches and pains. More recently, Crohn's, altho that was more straightforward medically. The lead up to Crohn's was a period of working too hard and going out too much in San Francisco.

mawadev 4y ago

I'm glad you found the root cause and were able to fix the issues. When I started reading this, I was shocked how that workplace exploited you to the brink of your existence. To the point you lost your identity. I can relate to this, running from one fire to the next, a constant race, while the managers laugh at the margin they achieve with low staff. The extra value you create for the price of your finite time and health. I'm angry at this injustice people have to subject themselves to. I tried to identify a problem within myself for years, but realized this once I got closer to management...

Wagthesam 4y ago
We exist in constant competition with one another for status and worth. But thankfully in this part of my career I have more choice as to what I want to do / the level I need to sacrifice.

Razengan 4y ago

I am extremely affected by outdoors noise during sleep. Traffic, construction, kids crying, people shouting.. I try my best to convince myself "I'm perfectly comfortable, nothing's happening in my bedroom, whoever is causing that noise can not affect me in any way" but to no avail :( If the source is indoors, like the whirr of a hard disk (very annoying on recent Macs + external hard disks, constantly spinning up and down) I have to turn it off before trying to sleep. It gets so bad that even the mere anticipation of an expected noise, a clang or a honk or a yell, prevents me from falling asleep. For me it's definitely psychological than physical. Sort of an arrogant insistence that everyone and everything should be silent while I rest. Thankfully when I'm really tired I stop caring about noise and just drop like a log.

Rechtsstaat 4y ago
Oh man, I know that feeling of dread as you're waiting for the next shout or clank. It took some time to try out various earplugs, which at first made me sleep even worse, but once I was used to wearing them while sleeping (after 2 weeks) the difference was night and day.
TinkersW 4y ago
Same here, but I found that silicon earplugs really help(the foam ones do not work).
naasking 4y ago
Start using a white nor brown noise machine. Noise issues like this are typically because the noise has lots of variation in volume, spikes in loudness, etc. The steady droning of a white or brown noise drowns out lots of that kind of background noise. I just use my phone, lots of free apps available. Ear plugs help too, though they can be irritating sometimes.

marhee 4y ago

> And I started taking antihistamines daily. Antihistamines can make you drowsy, ie. "brain foggy": (Quoting the web) Side effects of antihistamines * sleepiness (drowsiness) and reduced co-ordination, reaction speed and judgement – do not drive or use machinery after taking these antihistamines. * dry mouth. * blurred vision. * difficulty peeing. I take them sometime myself (for the same symptoms as the article) and I really notice the drowsiness - even though it differs from time to time. So I really limit usage. > Even my lifestyle in my early 20s was a confounding issue. Did I party too hard? Did that era of my life alter my brain chemistry in a way that made me irreparably damaged? Long-term effects of recreational drugs use (this includes alcohol I would say) have be studied quite a bit I believe not much last-long effects have been found. So don't worry about it, it does not alter your brain permanently. Finally I like to say that what helped the author a lot is just a shift in focus to personal well-being. Any shift in focus helps in most cases. Taking up dancing, playing guiter, camping, whatever, can also make you feel like you can breath again. Hyperfocus, on any kind of activity, can be damaging in the long run for most people. Variety is the spice (& fresh air) of life. But note that hyperfocus includes hyperfocus on personal health, well-being and mental health issues, etc. This can also be damaging and anxiety inducing, as you try to start "fixing" everything and trying to "understand" all your root cause in a infinite loop, start comparing with others, etc. So limit the time spend there as well, I would say.

iSnow 4y ago
>Antihistamines can make you drowsy, ie. "brain foggy" Depends. More modern ones like Desloratadine which don't cross the blood/brain barrier usually don't do so.
galleywest200 4y ago
Antihistamines make my insomnia worse. They trigger my restless leg syndrome like nobody's business. Stimulants (prescribed) help me sleep, they shut my brain up.
- KuiN 4y ago
  Restless Leg Syndrome is absolute hell. Combined with insomnia it's nearly killed me a few times. I think a lot of people (including many doctors I've dealt with) underestimate it due to it's rather benign sounding name.

tstrimple 4y ago

Hey! It's 2AM for me and I have a meeting in 4 hours and still can't fall asleep. This is pretty typical for me regardless of exercise or caffeine intake.

naasking 4y ago
Lots of changes you can try: https://hubermanlab.com/toolkit-for-sleep/ https://hubermanlab.com/toolkit-for-sleep/ You might also be a slow caffeine metabolizer, so even one morning coffee can disrupt your sleep for more than 24 hours.

eddyfromtheblok 4y ago

I also was offered a CPAP and I hated it. I ended up going to an acupuncturist and didn’t really have issues with sleep apnea after some treatments.

mfgs 4y ago

For anyone using or considering a CPAP device, you should also do some research into mandibular advancement devices (MADs). They’re basically a mouth guard that opens your airway by moving your lower jaw forward. They are lesser known than CPAPs but are much simpler and way less invasive. They’re often well suited for people who are thinner and/or have milder OSA symptoms. I couldn’t use a CPAP but using a MAD has helped significantly (although perhaps not completely).

marstall 4y ago
I have severe sleep apnea and made the switch from CPAP to MAD a couple years ago. Expensive but covered. Never looked back. Much simpler on every level, works about the same. My wife confirms I don't have apnea episodes.
- anonu 4y ago
  When you say "covered" you mean your insurance paid for it? Are you in the USA? I understand it's not covered unless you do a series of sleep studies.
  - marstall 4y ago
    yes, in the USA, yes - covered. and I did have to have a sleep test for the cpap, but not the MAD
Bilal_io 4y ago
I remember my sleep doctor mentioning them as an option, but with a risk of altering the jaw's shape.
- anonu 4y ago
  It's not really a risk. I use a MAD. In the morning I have a little insert that realigns my overbite and do 5 minutes of muscle exercises. If i don't do that i notice alignment issues when I'm chewing. If i do, it's not an issue at all throughout the day. There are studies that have shown that overbite decreases over time but it's not clear if they do the reset procedure every morning.

madaxe_again 4y ago

Sweet Jesus. The illness this young man has is an advanced case of capitalism, not sleep apnoea. While I still worked at the technology mill, my sleep was terrible, I had apnoea, I ground my teeth to stumps, and suicide was a frequent point of contemplation. I changed my life, entirely. Stopped subjecting myself to the incessant cruelties we are expected to accept as simply normal. We have an entire planet filled with people who absolutely know that something is wrong, but they can’t see the thing right in front of them, as it’s so normal and all-pervasive that it doesn’t even register as a thing that exists - so they go get the pills, the devices, the apps, and treat the symptoms so they can continue their good work at the torture factory. Things are better for me now. It required stopping giving a damn about career, success, and all that crap, and going and doing entirely my own thing. And they wonder why the birth rate is in the ditch. Stressed creatures in captivity do not reproduce.

inkcapmushroom 4y ago
>And they wonder why the birth rate is in the ditch. Stressed creatures in captivity do not reproduce. This seems reasonable, but I wonder why we are so much more stressed in modern first world countries than in places and times where they have had "real" problems, like figuring out how to source potable water or how to not get shot or bombed in a war-torn country. It's usually the case that the harder it is to survive an environment, the more people seem to reproduce, and birth rates go down after most citizens' well-being is secured, which would seem to run counter to the idea that stress lowers birth rates.
DrThunder 4y ago
Imagine thinking sleep deprivation doesn't exist in alternative economic structures... "It required stopping giving a damn about career, success, and all that crap, and going and doing entirely my own thing." So capitalism helped you. There are quite a few ism countries where 'doing your own thing' isn't an option.

jstx1 4y ago

Can something like a fitbit be used as an initial screen? Mine detects multiple very short sleep interuptions every hour during sleep and I have no idea how to interpret this. (I'm chronically tired and distracted and I have no idea where to start - sleep apnea, ADHD, food intolerances...)

jaggirs 4y ago
If you are chronically tired you should go see a doctor regardless of what the fitbit says.
ansc 4y ago
I believe that's completely normal (at least that's what my fitbit says). Unless I'm also suffering from sleep apnea of course.
Wagthesam 4y ago
Possibly. But you need continuous sp02 monitoring, whereas fitbits only do it a few times per hour. A take home sleep test is easy and is covered by insurance.
- bob_theslob646 4y ago
  >A take home sleep test is easy and is covered by insurance Do you know of any other alternatives for sleep tests that are not covered by insurance? Because the reality is sleep study in the United States is incredibly expensive. I did a sleep study and the insurance billed my company over $50,000 and a take home test was 2.5 grand.
  - Wagthesam 4y ago
    that seems like inflated pricing. there are solutions from the internet for hsat (lofta and night owl) that used standardized devices. If you want a psg, there's a place in sacramento (axg sleep diagnostics) that will mail you the psg device for a night, for around 600. My hsat was covered by insurance, but I had to self fund psg and my insurance wouldn't pay for it. My sleep specialist quoted 3k, I went with axg sleep diagnostics.

dusted 4y ago

I suspect I might have this.. Do anyone know a device which can continuously measure and log blood oxygen levels ? Just a simple thing that logs to a file on an SD card ? I don't want apps or online stuff..

bowsamic 4y ago

> I had reached a stage of mental illness. One that is not aesthetic and talked about to spread awareness. But one where people would avert their eyes. This period was a dark era in my life. This is actually all mental illness, we just seem to be really bad at dealing with it as a society. It's quite shocking how little empathy or support people seem to have for "unfashionable" mental illness.

Wagthesam 4y ago
Yeah. Kanye is a roscharch test. Mental illness is not pleasant or even easy to pity. It will offend you. It can be disturbing, violent, and insane. I have no ideas, this is just the way things are

bitL 4y ago

How about trying acetazolamide or high dose thiamine (1500mg+) for it? They both act as carbonic anhydrase inhibitors, therefore could be used to treat altitude sickness and thus be beneficial for (central) sleep apnea as well.

Wagthesam 4y ago
I don't have central apnea thankfully. One thing to note

kartiksura 4y ago

I recently went through a surgery for treating my sleep apnea. I have documented my experience here. Happy to answer any of your questions https://www.quora.com/profile/Kartik-Sura/My-Struggle-with-ADHD-was-Actually-Sleep-Apnea-All-Along https://www.quora.com/profile/Kartik-Sura/My-Struggle-with-A...

Wagthesam 4y ago
congrats on your recovery!

spirit557 4y ago

I'm trying to understand how exactly do they know sometimes if there is central sleep apnea or obstructive sleep apnea happening with the tests. Is a CPAP or other machine helpful for central sleep apnea?

david-gpu 4y ago
When CPAP machines detect that the airflow has stopped for a few seconds, they send a series of little air puffs to determine whether the airway is still open (non-obstructive apnea) or blocked (obstructive apnea). The puffs are gentle enough that they don't wake you up and don't force the airway open.
elric 4y ago
If you're talking full-blown sleep study with all the sensors, then it's pretty easy. If you're attempting to breathe but no air goes in: it's obstructive. If you're not attempting to breathe, it's central. You can detect whether or not someone is trying to breathe by looking at the chest strap reading. The cause of central apneas isn't always clear, but at high CPAP pressures it can be caused by CPAP, because it can end up blowing off CO2, and breathing is done primarily in response to an increase in CO2.
Wagthesam 4y ago
if you suspect central sleep apnea, you need to work with a specialist that has done research in central sleep apnea. Its a poorly understood condition. But from my understanding treatment is different

petesergeant 4y ago

I’m a member of an entrepreneurs forum where every so often someone will ask about improving their sleep. People are willing to try literally any pill they can source or rare Chinese medicine or vinegar diet or whatever, but what they are usually not willing to do is go and get a sleep study done and find out if they have sleep apnea.

FollowingTheDao 4y ago

I share here with you all that sleep apnea can be cured. I helped cure a friend by using her genetics and diet/life changes. No more mask. And her fatigue an peripheral neuralgia is gone. It had to do, for her, Vitamin D3, catalase, and selenium. This increased her somatostatin levels, growth hormone levels, and lowered her H2O2. https://pubmed.ncbi.nlm.nih.gov/29482804/ https://pubmed.ncbi.nlm.nih.gov/29482804/ https://www.acpjournals.org/doi/abs/10.7326/0003-4819-121-7-199410010-00002 https://www.acpjournals.org/doi/abs/10.7326/0003-4819-121-7-... Genetically, she is predisposed to very high levels of IFGBP3 and very low levels of catalase. She also has hasimotos (autoimmune thyroid) which I am sure will go away next. https://europepmc.org/article/med/17074268 https://europepmc.org/article/med/17074268

aantix 4y ago

I recently discovered that I’m a slow metabolizer of caffeine. Via my raw 23andme data. https://you.23andme.com/tools/data/?query=rs762551 https://you.23andme.com/tools/data/?query=rs762551 C/C genotype. https://www.geneticlifehacks.com/liver-detox-genes-cyp1a2/#CYP1A2_Genotype_report https://www.geneticlifehacks.com/liver-detox-genes-cyp1a2/#C... Instead of coffee being a net positive, it actually takes caffeine 4X the time to process through my body and increases my cardiac event risk by 2X. I can drink a cup of coffee at 8am and it still impacts my sleep the following night. My blood pressure remains really elevated (20+ points for systolic) the entire day. All these decades I’ve been ingesting coffee thinking it’s a “net positive” - not for my genotype. When the reality is I sleep like shit, my blood pressure is through the roof, I feel awful for a day or two of drinking a single cup, and it all makes sense now. I miss my coffee kick, but the fallout from it all, I just don't think it's worth it anymore at this stage of my life.

_rs 4y ago
Are there any services like 23andme that are more strict when it comes to data privacy or that allow me complete ownership of the data? I would love this type of analysis even at a higher cost but I am scared of what might happen in the future to this data on me and children
- manimino 4y ago
  I have used Nebula. Did a group buy of the kits with several friends to obfuscate shipping address. Signed up via a protonmail address, and accessed the site only through VPN. Then deleted my data after downloading all of it. I believe it would be very difficult to tie my identity to my genome because of these steps.
  - nordsieck 4y ago
    > I believe it would be very difficult to tie my identity to my genome because of these steps. That probably depends on the closest relatively of yours that they have in their database. If you only have one sibling and they're in the database, you're probably boned no matter the precautions you take.

raspberry1337 4y ago

Hello WagTheSam, thanks for a good write up. Can I just ask, what air cleanser did you get? I am thinking of trying this, I don't trust my apartment buildings air vents. What is the gain compared to just opening a window - if you live in a not too toxic environment?

endorphine 4y ago
Opening your window during pollen season will wreck you, if you have spring allergies, for example.
- Wagthesam 4y ago
  Yes opening windows brings in dirt and car fumes and pollen. AC and air purifiers much better for environmental health
tencentshill 4y ago
A DIY Corai-Rosenthal box would be the most cost-effective one. https://www.brown.edu/news/2022-12-23/corsi-cubes-study https://www.brown.edu/news/2022-12-23/corsi-cubes-study
joveian 4y ago
AirPura is one of the good ones: https://www.airpura.com/ https://www.airpura.com/ I have one and it felt nice, unfortunately because people smoke in the building I live I can't use it since the smell collects in the filter very quickly and they are expensive (but last a long time if not for the smell). A bunch of carbon could help with that but a) I try to avoid stuff from low wage countries as the carbon is (but not the rest of that particular air purifier as far as I could tell) and b) hopefully I can just move in the not extremely distant future. There are a few others as well, look for the better quality filters ("SuperHEPA" as AirPura calls them). As I understand it, the small particles are the ones that aggrivate allergies the most and that is exactly what the higher quality filters are better at. Only a relatively few companies have those better filters, IQAir is another one. It turns out the name HEPA doesn't mean anything for consumer filters, you need to look at the specs.
4y ago

nunez 4y ago

I get insomnia. I've been doing CBT-i for a month. It's been transformational. Throughout this experience, I've learned a lot about sleep that I wouldn't have learned otherwise. 8 hours of sleep per day is generally a myth. The amount of sleep people need varies from person to person. Ironically, fixating on getting eight hours can cause some people to get insomnia. Insomnia is a condition that is often caused by something (like work stress for the author) but drastically overstays its welcome. My CBT-i program emphasizes that trying to determine the root cause of the insomnia is pointless because of this phenomenon. This theory of how insomnia develops is called the 3P model and was developed by Dr. Arthur Spielman in the NINE TEEN EIGHTIES. (We've been sleeping for thousands and thousands of years!) https://insomnia.sleep-disorders.net/clinical/three-factors-model https://insomnia.sleep-disorders.net/clinical/three-factors-... Sleep apnea is super duper common. But the world (well at least the US) prides itself on working harder and sleeping less. I've met tons of people who start work at 6am but "get to sleep" (usually means "get to bed") at 10pm or later, partially because they wrap up work at home. There is an over-fixation on the long-term degenerative effects of sleep. However, those effects are poorly understood because sleep in itself is poorly understood. You can't really control sleep. That blew my mind. You can train yourself to get sleepy on a schedule, but actually falling asleep isn't up to you. This is why a lot of common sleep hygiene advice isn't that effective (or is actually regressive) long-term. CBT-i focuses a lot on this in particular. Alcohol and sleeping pills DESTROY sleep. That is one of the few things about sleep that is extremely well understood. These things help people get to stage 1 sleep but inhibit the deeper sleep stages that start recovery processes. (The author took antihistamines for years. Antihistamines are used as sleep aids, though they are habit-forming and can cause gnarly insomnia when you get off of them without weaning off.) So I agree with the author. I strongly believe that ALMOST EVERYONE in the US struggles with sleep, but, like sex, talking about that is taboo and drugging your way through the solution is socially acceptable.

DrThunder 4y ago
I would agree with almost all of this. The worst bouts of insomnia I had were caused by going without sleep for a day or two and then starting to fixate on all the issues it might cause if I did not sleep. The anxiety surrounding the problems I would have the next day with little sleep was the biggest culprit. You stick yourself in a programmatic loop by trying so hard to make yourself sleep. As you said, sleep just happens, you don't force it. Generations of people have gone on very little sleep for decent stretches of time. It is impossible for your body to not sleep and at some point it will happen whether you want it to or not. Fixation on making your sleep better will only do the opposite. Do the main things that help sleep - exercise, no caffeine after noon or so (if you're on normal day schedule), get off the screens at night near bed time and wind down appropriately. Other than that you must take an attitude of 'So what if I don't sleep. I'll feel slightly bad tomorrow and that's about it'. You will not suffer all that many long term effects of a little sleep deprivation here and there.

deleted 4y ago

[deleted]

hobo_mark 4y ago

Without immediate access to at-home sleep test kits, could something like Sleep as Android [1] (which claims to record breathing as well) be used to find out, in a first approximation? [1] https://sleep.urbandroid.org https://sleep.urbandroid.org

Wagthesam 4y ago
No because the diganostic criterea is nasal restriction + sp02 decrease. Or microarousals scored manually by a specialist from an ecg. You need a physical device measuring these signals

slothtrop 4y ago

Had crippling insomnia for most of 15 years. It's the worst thing that ever happened to me and I would not wish it on anyone. I'm convinced I've lost years of my life - not just in the sense of wasted time, but shortened life. But no use being bothered about it. The mainstream knowledge is still slow to catch up, but things are better than when I was researching at the outset. All you had from online searches was boilerplate inconsistent "sleep hygiene" advice and nothing else. I took a methodological approach and cracked open some books, and spent a lot of time on google scholar / pubmed. Self-adminstered CBT-i was an important intervention, despite its flaws - you can gripe that there are blind spots (e.g. it's possible to have automatic negative thoughts through conditioning despite knowing and understanding that they are distortions, 3rd-wave approaches like MCT make it a point to handle this), but in the main, a better mental game is absolutely key. Other interventions included eliminating pornography consumption, exposure to more sunlight in the morning and daytime, limiting total time in bed, experimenting with bedding, and even dietary changes. There were others as well I can't think of right now. Basically threw the kitchen sink at it. The mistake I often see is that those afflicted will rationalize that trying interventions "will lead to anxiety". There's no reason they have to. The anxiety comes from you.

gwbas1c 4y ago

I found out I had sleep apnea mostly due to coincidence. Eventually I got jaw surgery to fix it, but there is a surprising anecdote: Shortly after I started using a CPAP, at a networking event I met someone who worked at a mental health clinic, and he told me that many of their patients with schizophrenia had a pressure setting of 18 or 19 bars. Apparently disturbed sleep can cause some rather severe mental illness. I was at 16 bars at the time. (I no longer use a CPAP post surgery.) About a year prior, there were a few times that I wondered if something actually happened, or if I was misremembering a dream. It makes me wonder if some severe forms of sleep apnea can make dream context confusing enough that it's hard to bucket memories between dreams and actual events?

Wagthesam 4y ago
Late stage untreated UARS is similar to a catatonic existence. I think Christian Guilleminault described this population in his research. Thankfully even my experience did not get to this point
- bandanah12 4y ago
  can you share the paper or article?

pfes 4y ago

I also had a positive experience of taking a sleep study, getting diagnosed with partial sleep apnea, and getting surgery to open up my nasal passage. I had been wearing breathe-right strips, having been unable to sleep through the night without them.

FgvGCa79FxVkSh2 4y ago

Pininiyo3@gmail.com

FgvGCa79FxVkSh2 4y ago

pininiyo3@gmail.com

transfire 4y ago

Sadly CPAPs are money train for the medical industry. Something that probably costs about $60 to make in China will cost you ten times that up front plus $60 a month (with insurance!) Their are other permanent solutions that would work for many people, but but those have been made largely unobtainable.

71a54xd 4y ago

This happened to me after making a rash decision about a new apt in NYC. When I visited to view the apt it must've been at a time when street noise / people noise was at all time lows. About a month into living there my work productivity tanked, I started noticing patterns of depression coming back and I legitimately started to hate my life. My sleep wasn't atrocious, but I'd be jarred awake in the morning by vehicles, had to wear earplugs at night etc. This drove me to a point of literally leaving New York entirely and I don't think I'll ever go back due to my current apt (in a different state) being completely quiet, having a dedicated dark silent room to sleep in and another room for working (as I'm full remote now).

samuraixp 4y ago

So happy for the author that they discovered the solution to their chronic health issues. Some estimates suggest that 10% of the population are suffering undiagnosed health issues. Thats a lot of people whos quality of life is being potentially severely disrupted because the health system is not designed to provide deep dive diagnostics. Surely the productivity gains in solving these health issues would easily pay for themselves. I hope this is an area where AI will truely shine by providing an effective stepwise differential diagnosis for anyones set of vague symptoms and conflicting biomarkers.

ahstilde 4y ago

It's interesting he mentions allergy shots. It sounds like his doctor didn't know about sublingual immunotherapy. It's similarly effective, but much less disruptive to the ongoings of daily life. Disclaimer: I run Wyndly (https://www.wyndly.com/ https://www.wyndly.com/) a YC-backed startup that uses sublingual immunotherapy, among other allergy treatments, to help people breathe better.

Wagthesam 4y ago
I know about SLIT, but from my research most allergists don't mix in enough to make it comparable to shots. From studies I read you need 30-100x the dose of shots taken in monthly aggregate for it to be comparable. For example Odactra which is fda approved for dust mites is 30x the concentration of a monthly maintenance dose. I am allergic to almost everything, so I imagine it will be too costly to treat properly Also it is much less regulated as its not fda approved, so the quality you are getting is less certain than shots. I would not be surprised if the majority of SLIT use cases in the US are placebo due to cost constraints outside of the fda approved tablets covered by insurance. Yes studies is one thing and its shown clearly that its comparable, but you need the right concentrations TBH I am skeptical of startups that operate in this type of environment as theres not enough oversight. For me to be comfortable it would need to be very transparent what is going into the mix source: https://fairfieldcountyallergy.com/whats-the-story-on-allergy-drops/ https://fairfieldcountyallergy.com/whats-the-story-on-allerg... "Sublingual immunotherapy is not currently covered by health insurance companies in the United States because it is ineffective as it is done here"
- ahstilde 4y ago
  I agree with you -- the protocol is what matters. Your concern about the dosage applies to allergy shots, too, however. At Wyndly, our protocol follows the academic research. I'll work on making this more explicit.

bob_theslob646 4y ago

If the effectiveness of sleep studies does not detect sleep apnea then how is it possible that the studies are so expensive? If they're not fully effective, why are there not other solutions?